Involvement and readiness of fellows from Papua New Guinea’s Field Epidemiology Training Programme in the COVID-19 response, 2020–2021

Problem Fellows of the Papua New Guinea Field Epidemiology Training Programme (FETP) were part of the national coronavirus disease (COVID-19) response. However, the specific activities and challenges experienced by fellows in the field were unknown. Context The advanced FETP cohort commenced just before the COVID-19 pandemic and all fellows were involved in the response. The advanced fellows participating in this review represented a cross-section of the country’s public health workforce. Action A review was conducted to better understand the scope of activities undertaken by FETP fellows, identify the challenges experienced and assess how well the programme prepared fellows for their COVID-19 response roles. A facilitated discussion based on the World Health Organization COVID-19 intra-action review methodology and an online survey was conducted with advanced FETP fellows. Outcome The fellows made important contributions to the national COVID-19 response by assuming leadership positions at all levels of government, leading training activities and applying core field epidemiology competencies in surveillance and response activities. The programme had prepared them well for the response, giving them the confidence and skills to undertake a diverse range of response roles. Discussion The FETP review of the COVID-19 response in Papua New Guinea highlighted the role and influence of the fellows during the pandemic response. Fellows were able to apply core field epidemiology competencies across a range of roles. The recommendations derived from this review will be instructive for the FETP specifically and the COVID-19 response generally.


Involvement and readiness of fellows from Papua New Guinea's Field Epidemiology
Training Programme in the COVID-19 response, 2020-2021 Flint et al Papua New Guinea's FETP COVID-19 readiness, 2020-2021

Facilitated discussion
A 1-day review was held with aFETPNG fellows during their second face-to-face training workshop. We adapted the World Health Organization (WHO) COVID-19 intraaction review methodology, 11 framing discussions with FETP fellows around WHO's emergency response pillars which were used to guide a country's COVID-19 response. 12 The pillars we focused on were: • Risk communications and community engagement (pillar 2); • Surveillance, case investigation, laboratory (pillars 3 and 5); • Case management and infection prevention and control (pillars 6 and 7); and • Operational support and logistics (pillar 8).
Facilitated discussions identifying what went well and what went less well during the COVID-19 response were held, which included a root cause analysis. 11, 13 Findings from the root cause analysis were used to develop recommendations for action.

Online survey
Understanding the contribution of aFETPNG fellows during the COVID-19 response, their role, how well prepared they felt and their confidence in performing key field epidemiology tasks during the response was carried out through an online survey. 13 The survey also asked how FETPNG could better prepare fellows for future infectious disease emergency responses.

Facilitated discussion
The findings from the facilitated discussion and key recommendations derived from root cause analysis were organized into four groups based on the WHO pillars ( Table 1).

Online survey
Fifteen (88%) aFETPNG fellows responded to the survey. All 15 (100%) were involved in the COVID-19 response in on 6 March 2020 and the country has experienced multiple waves since that time, relying heavily on international and domestic border control measures as well as contact tracing, quarantine and isolation to suppress transmission and preserve health systems. 1,2 As of 22 August 2022, 44 861 confirmed cases of COVID-19, including 664 deaths, were reported in PNG. 3 FETPs are supervised, on-the-job, competencybased training programmes for public health professionals. They train field epidemiologists to collect, analyse and interpret public health information, using evidence to take action and save lives. The skills of locally trained field epidemiologists are well suited to support public health emergency response activities. 4 As health security concerns have grown globally, FETPs have become increasingly recognized in global, regional and national preparedness and response mechanisms. The aFETPNG cohort commenced in 2019 just prior to the COVID-19 pandemic, and work in 13 of PNG's 22 provinces (59%). They represent all levels of the government's public health workforce, with fellows recruited from district (n = 7), provincial (n = 9) and national levels (n = 1). The substantive roles of fellows included surveillance officers, health extension officers, district health managers, disease programme managers, provincial disease control officers, the FETP convenor and a provincial deputy director of public health. Core FETP competencies, such as disease surveillance, outbreak response and data analysis, were all highlighted as being useful in preparing fellows for the COVID-19 response. Fellows also identified that the PNG. When asked about their involvement in COVID-19 throughout 2021, just over half (53%; n = 8) reported working full time on the response. Of those not in a fulltime role, 13% (n = 2) worked on the response 3-4 days per week and 33% (n = 5) 1-2 days per week.
The most common COVID-19 response roles undertaken included leading surveillance activities, providing advice to stakeholders, leading rapid response teams (RRTs), contact tracing and conducting training. The majority (80%; n = 12) of fellows received specific train- • Provide targeted education and incentives to promote vaccination of HCWs at all levels "There is recognition of FETP grads who are identified to take lead roles in the response." "From the FETP training -we could actively participate as a team lead in RRT, conduct contact tracing, case investigation and surveillance -across all areas of response." Fellows felt most confident supporting or leading case investigation and contact tracing activities, and least confident supporting or leading risk communication, community engagement, specimen handling and FETP provided them with confidence, enabling them to fill leadership roles, conduct public speaking and influence decision-makers. • develop mechanisms to support graduates in the ongoing application of FETP knowledge and skills in the workplace through activities such as individual and group-based projects for graduates and ongoing mentorship (including during outbreak response activities); • develop and deliver a sensitization training programme for senior management to promote the best utilization of field epidemiology graduates in the workplace; and • advocate for the creation of designated field epidemiology positions within the public health service, providing a clear career pathway for graduates.
This FETP COVID-19 review was limited to fellows enrolled in the advanced FETP and did not include feedback from fellows or graduates of the intermediate FETP.
Thus, these findings are not representative of all FETP fellows and graduates and cannot be generalized to the whole FETPNG population.
This COVID-19 review supports a culture of ongoing reflection and evaluation. The recommendations are instructive for FETPNG specifically and the COVID-19 response generally. Findings from this review support previous work focusing on workforce issues during emergency responses. 4,14,15 This review has highlighted the important contribution of the FETP fellows during the COVID-19 response, and the need for the programme to adapt to better prepare PNG's field epidemiology workforce for future challenges.
shipping, and infection prevention and control activities (Supplementary Table 1).
Areas for strengthening the response capacity of graduates included further training on tools to support surveillance, data management, analysis and interpretation, risk communications and community engagement, psychological first aid, management and leadership during public health emergencies, and the establishment of RRTs. Fellows highlighted a need for more careful consideration and inclusion of gender issues when responding to emergencies and commented on connectivity challenges associated with virtual training.
Most fellows (93%; n = 14) reported that the intermediate and advanced FETPs were very helpful in preparing them for the COVID-19 response, while one respondent (7%) indicated the programmes were moderately helpful. Half (n = 7) of the fellows indicated that their manager was very aware of their skills as a field epidemiologist, 36% (n = 5) of managers were somewhat aware and 14% (n = 2) were not aware. Most of the fellows (79%; n = 11) indicated that their skills in field epidemiology were well utilized by their managers during the COVID-19 response.
When asked what could be done to improve the use of FETP graduates and fellows by management, the following themes emerged: (i) the need for management to recognize the potential of field epidemiologists and make use of them in leadership positions; (ii) the creation of designated field epidemiology positions within the public service; (iii) FETP sensitization training for managers; and (iv) the need for FETP fellows and graduates to appropriately manage up, including proactively presenting their surveillance and project findings to management.

DISCUSSION
The COVID-19 review highlighted the role and influence of aFETPNG fellows during the pandemic response. Fellows were able to apply core field epidemiology competencies across a range of roles. The diversity of their roles highlights the value and versatility of field epidemiologists in public health emergencies. While the majority of fellows found the FETP training very helpful in preparing them for a pandemic response, they identified areas for improvement.